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• Interveening in childrens' health
  Richard G. Wilson
  Published on: 22 March 2016

• Published on: 22 March 2016

  Interveening in childrens' health

  • Richard G. Wilson, Hon. Consultant

  Mitch Blair's article is an important commentary on the relationship between academic enquiry and changes which affect child health, and justifies some amplification. The two examples he relies on are very different and obscure a third. The benefit of antenatal steroids in reducing R.D.S. was based on research but occurred as a result of a steady increase in collaboration of paediatricians (responsible for treatment of R....

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  Mitch Blair's article is an important commentary on the relationship between academic enquiry and changes which affect child health, and justifies some amplification. The two examples he relies on are very different and obscure a third. The benefit of antenatal steroids in reducing R.D.S. was based on research but occurred as a result of a steady increase in collaboration of paediatricians (responsible for treatment of R.D.S. ) and obstetricians (responsible for prescribing steroids). This started in the 1970's and allowed the agnostics to gradually convert, rather than by a sudden watershed in 1990.

  The cot death story obscures the major alteration in infant care which aroused little comment in this country ,although it did in the Netherlands. Clear evidence that preterm infants benefited from lying prone led to a major change, instigated mainly by midwives who felt that 'normal' babies should not be excluded from the benefits given to those in 'Special Care'. Both midwives and mothers noted that some babies slept more soundly when prone.

  Ruth Gilbert has documented how evidence for the adverse effect of prone sleeping was accumulating, but the studies were observational , of small numbers and with confidence limits which nobody judged sufficient to advise changing the sleeping position of what had become the majority of infants.

  In 1989 F.S.I.D. recognised that the search for medical diagnoses had only been successful in a few cases, and Risk Related Intervention was not practical for the whole population. I set up a working group, including leading professionals , to advise on the most promising measures which might reduce deaths and could be advised for virtually all babies.Sufficient evidence from intervention studies was lacking, although there were documented initiatives advising locally on issues such as overheating and prone sleeping.

  Early in 1991 Ed Mitchell published results of the New Zealand intervention study which reached a wider community at a meeting in Rouen that summer. This was judged sufficient for action; a campaign was swiftly prepared based on the recommendations of the working party and F.S.I.D. launched the "Reduce the Risk " campaign in October. The delay in acting on evidence was in months not 20 years. The D.O.H. followed with television advertisements ,a temporary leaflet('Back to Sleep') and funding for the C.E.S.D.I. study.

  To make significant improvements one needs more than well founded research; the data and the arguments for change must be easily available and understandable., and robust enough to prevent calls for more research before action. The benefits should be major and the risks minimal. The agents of change , parents, nurses and midwives, and medical staff all have individual needs in the way information is presented, and while the state needs to take ultimate responsibility a bureaucratic response could bring its own disadvantages including a lack of motivation .

  Conflict of Interest:

  Former Trustee; Foundation for the Study of Infant Death

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  Conflict of Interest:
  None declared.

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